Few modifiable risk factors for preterm birth (PTB) and intrauterine growth retardation (IUGR) have been identified. Poor cardiovascular health during the pregnancy can lead to preterm birth (PTB), but the effect of pre-pregnancy cardiovascular health on birth outcomes is not clear. Our long-term goal is to determine the causes of and ultimately develop interventions that can reduce the incidence of and disparities in PTB/IUGR. Our overall objective with this project is to determine the relationship between pre-pregnancy cardiovascular risk, from childhood through early adulthood, and birth outcomes. Our central hypothesis is that high cardiovascular risk across the lifespan predicts poor pregnancy outcome and partially accounts for racial disparities in these outcomes. We plan to take advantage of the data collected in the Bogalusa Heart Study, a long-running biracial (black/white) study of cardiovascular health in children and young adults. The study includes data on almost 6000 women, now in their late reproductive years. We propose to link to vital records data (estimated N=3980), interview participants about their pregnancy history (estimated N=3060), and request medical records for their pregnancies (estimated N=1330). We will then examine the relationship between cardiovascular disease (CVD) risk factors across the lifespan, birth outcomes, and pregnancy complications. Our specific aims are 1. To determine the impact of mother's CVD risk factors (high blood pressure, dyslipidemia, hyperglycemia, hyperinsulinemia, obesity) in childhood and adolescence on birth outcomes of her babies (preterm birth (PTB) and intrauterine growth retardation (IUGR)) in a black and white population; 2) To examine the relationship of longitudinal changes of mother's CVD risk factors from childhood to adulthood to birth outcomes in black and white individuals); 3) To determine whether pre-pregnancy CVD risk factors are associated with pregnancy complications (gestational hypertension, gestational diabetes and pre-eclampsia), and whether this explains the relationship between pre-pregnancy cardiovascular risk and PTB/IUGR; 4) To determine whether differences in CVD risk factors explain racial disparities in birth outcomes. The contribution of the proposed research is expected to be linking pre-pregnancy cardiovascular health across the life span with pregnancy outcomes. This will be significant because we will identify novel risk factors, timing, and subpopulations for interventions that could reduce the incidence of and disparities in PTB/IUGR. This proposal takes advantage of the unique opportunity to use 35 years of longitudinal research, beginning in childhood, in a biracial population.